Poneke Kyokushin Registration Form
Please complete this form once for each person who may be interested in becoming a member.

This completed form will be emailed to the address provided. Please print the completed form and give it to the instructor when you arrive at your first session.

Someone will be in touch with you to discuss membership. You will not be registered as a member of Poneke Dojo until you confirm your interest by becoming financial / paying on invoice.

Personal Information
Student's First Name *
Your answer
Surname *
Your answer
Date of Birth *
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Gender *
Contact Details
Contact Name (Parent or Guardian for kids)
Your answer
Mobile Phone Number
Your answer
Other Phone Number
Your answer
Email Address *
Your answer
Street Address *
Your answer
Suburb
Your answer
City *
Your answer
Postcode
Your answer
Any Other Contact Information
Your answer
Training Preferences
Select up to two options *
Required
Select preference *
Based on student age, size, maturity and personal goals
To help the Club
How did you hear about Poneke Dojo?
Acknowledgements
Kyokushin Karate is a traditional Japanese martial art that requires intense physical exertion. Full contact fighting is a component of Kyokushin. While every effort is made to protect the comfort and safety of all students there is an inherent risk of pain and injury.
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